Annet L van Rijssen1, Hein Ter Linden, Paul M N Werker. 1. Zwolle and Groningen, The Netherlands From the Department of Plastic, Reconstructive and Hand Surgery, Isala Clinics, and the Department of Plastic Surgery, University Medical Centre Groningen, and the University of Groningen.
Abstract
BACKGROUND: The increasing number of methods for treating Dupuytren's disease indicates a need for comparative studies. In this article, the 5-year follow-up results of a randomized controlled study that compared percutaneous needle fasciotomy and limited fasciectomy are presented. METHODS:One hundred eleven patients with 115 affected hands with a minimal passive extension deficit of 30 degrees were assigned randomly to the two groups. Follow-up examinations were performed at 1 and 6 weeks; 6 months; and 1, 2, 3, 4, and 5 years. Outcome parameters were total passive extension deficit, patient satisfaction, flexion, and sensibility. Furthermore, disease extension was recorded. The primary endpoint was recurrence, defined as an increase of total passive extension deficit of greater than 30 degrees. Ninety-three patients reached this endpoint. RESULTS: The recurrence rate after 5 years in the needle fasciotomy group (84.9 percent) was significantly higher than in the limited fasciectomy group (20.9 percent) (p < 0.001), and occurred significantly sooner in the needle fasciotomy group (p = 0.001). Older age at the time of treatment decreased the recurrence rate (p = 0.005). No other diathesis characteristics influenced recurrence. Patient satisfaction was high in both groups but was significantly higher in the limited fasciectomy group. Nevertheless, many patients (53 percent) preferred percutaneous needle fasciotomy in case of recurrence. CONCLUSIONS:Percutaneous needle fasciotomy is the preferred treatment for elderly patients with Dupuytren's disease and for those willing to accept a possible early recurrence in the context of the advantages, such as fast recovery, a low complication rate, and minimal invasiveness. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
RCT Entities:
BACKGROUND: The increasing number of methods for treating Dupuytren's disease indicates a need for comparative studies. In this article, the 5-year follow-up results of a randomized controlled study that compared percutaneous needle fasciotomy and limited fasciectomy are presented. METHODS: One hundred eleven patients with 115 affected hands with a minimal passive extension deficit of 30 degrees were assigned randomly to the two groups. Follow-up examinations were performed at 1 and 6 weeks; 6 months; and 1, 2, 3, 4, and 5 years. Outcome parameters were total passive extension deficit, patient satisfaction, flexion, and sensibility. Furthermore, disease extension was recorded. The primary endpoint was recurrence, defined as an increase of total passive extension deficit of greater than 30 degrees. Ninety-three patients reached this endpoint. RESULTS: The recurrence rate after 5 years in the needle fasciotomy group (84.9 percent) was significantly higher than in the limited fasciectomy group (20.9 percent) (p < 0.001), and occurred significantly sooner in the needle fasciotomy group (p = 0.001). Older age at the time of treatment decreased the recurrence rate (p = 0.005). No other diathesis characteristics influenced recurrence. Patient satisfaction was high in both groups but was significantly higher in the limited fasciectomy group. Nevertheless, many patients (53 percent) preferred percutaneous needle fasciotomy in case of recurrence. CONCLUSIONS: Percutaneous needle fasciotomy is the preferred treatment for elderly patients with Dupuytren's disease and for those willing to accept a possible early recurrence in the context of the advantages, such as fast recovery, a low complication rate, and minimal invasiveness. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.